Caldolor

[jengal]

Dr. Hale,
Hi! First of all we want to say that we enjoyed your conference last spring in Jacksonville, FL and have been working on some changes with pain meds in our post-partum mothers. Our physicians are interesting in using IV ibuprofen with their C/S mothers and we called the IRC about your recommendations. Patsy said she was able to speak with you about it and that the recommendation was to wait 1 hr after administration to breastfeed and we passed this information along our staff working on new protocols. After making these recommendations our head of Pharmacy has requested we get information about the recommendations on waiting the 1 hour to breastfeed and from what research articles we could use to stand by that recommendations. Their alternative to the Caldolor is IV acetaminophen and toradol. He states the toradol is the same drug class as the caldolor and that toradol can be used in breastfeeding women with no wait on breastfeeding after administration. Is there any feedback and research that can be presented to the pharmacy as far as the recommendations on using Caldolor in breastfeeding mothers? Their protocol is to discontinue the demerol for C/S mothers and in place administer 800mg Caldolor q 8 hrs x 2 doses once admitted to recovery then d/c to PO ibuprofen. We appreciate you taking a moment to help us! We look forward to hearing you speak again soon!

[admin]

Dear Jengal

We looked at the pharmacokinetic profile of IV ibuprofen (Caldolor) and compared that to oral ibuprofen. Within 1 hour the plasma concentrations of Ibuprofen after IV administration are going to be similar to the plasma concentrations after oral doses. We know oral ibuprofen enters milk only in very low levels (less than 0.7% of maternal dose). Even large doses produce very small milk levels. We chose the 1 hour interval to wait so that it would mimic our experience with oral doses.

The suggestion of Ketorolac (Toradol) while interesting has not been studied following IV doses, but only orally. Thus, we can not confirm that IV Ketorolac (Toradol) is safe immediately after IV administration.

A good reference comparing IV versus oral Ibuprofen is:
Smith HS, Voss B. Pharmacokinetics of intravenous ibuprofen: implications of time of infusion in the treatment of pain and fever. Drugs. 2012 Feb 12;72(3):327-37.

Hope this helps! For further questions, please call the InfantRisk Center at 806-352-2519.

Tassneem Abdel Karim MD
InfantRisk Center